Scorecard: Access to Healthcare Rose Under Obamacare

ACA a winner for population health, Commonwealth Fund says

Researchers found significant gains in access to healthcare and across nearly four dozen healthcare performance measures since the implementation of key Affordable Care Act (ACA) provisions five years ago.

A report showing that fewer people lacked health insurance in the years following the healthcare reform law's coverage expansion was released Thursday by the Commonwealth Fund.

Data in the organization's annual Commonwealth Fund Scorecard shows that the positive impact of the ACA is undeniable, David Blumenthal, MD, president of the nonprofit healthcare think tank, told reporters Wednesday.

"It is clear that states, especially those that have expanded Medicaid, have made substantial progress in ensuring that their residents have health insurance. Millions are better able to get the healthcare they need since the law was passed, and the quality of care has improved for many."

The Commonwealth Fund scorecard evaluates 44 indicators grouped into four dimensions of performance: access and affordability, prevention/quality, avoidable hospital use and costs, and healthy lives.

Blumenthal emphasized widespread gains in patient safety in doctors' offices and hospitals and said the study helps set the bar for proposals to repeal and replace the ACA.

"We must hold onto the gains that we have made and build on them to improve even more. We must ensure that people in every state and community can benefit from the achievements of the past five years."

State Rankings

Vermont earned the highest ranking in the scorecard study, followed by Minnesota, Hawaii, Rhode Island, and Massachusetts. Mississippi received the lowest ranking.

The scorecard study found several healthcare-performance improvements that likely are related directly to the ACA:

Gains in the rate of health insurance coverage and the ability to access care when needed

Higher levels of treatment quality and patient safety

Reductions in hospital readmission rates

While the scorecard study shows a considerable amount of performance variation in the delivery of healthcare services, gains from the ACA are measurable and widespread, according to the report.

Medicaid Expansion Revved Performance Gains

It notes that nearly all state health systems improved on a broad array of health indicators between 2013 and 2015. The period coincides with implementation of the ACA's major coverage expansions.

The most significant healthcare-performance gains were observed in states that accepted Medicaid expansion.

Those states typically ranked higher than non-expansion states before and after the law's coverage expansions, but also saw the greatest gains in healthcare access between 2013 and 2015.

States that achieved double-digit reductions in their uninsured rate for working-age adults between 2013 to 2015 -- Arkansas, California, Kentucky, Nevada, New Mexico, Oregon, Rhode Island, Washington, and West Virginia -- all expanded Medicaid as soon as federal resources became available in 2014, according to the report.

Room for Improvement

Despite the many gains highlighted, researchers identified some areas of concern.

Disparities in healthcare were found to be persistent among low-income populations. And the rate of premature death (before age 75) could have been lower during the study period if access to coverage had increased slightly in 30 states, research suggests.